Television viewing, leisure-time exercise and acute coronary syndrome in transitional Albania
Introduction
In developed countries, the inverse association of leisure-time exercise with coronary heart disease (CHD) is well-established (Leon et al., 1987, Morris, 2005). Reports have linked television (TV) viewing to increased rates of physical inactivity (Hu et al., 2003), obesity (Hu et al., 2003, Jakes et al., 2003), diabetes (Hu et al., 2003, Hu et al., 2001) and CHD risk factors (Fung et al., 2000, Jakes et al., 2003). However, there is scant evidence on the association of TV viewing with CHD itself.
Survey data on exercise in transitional countries of Southeast Europe are scarce, especially for Albania which, up to the collapse of the Stalinist regime in 1990, was the most isolated communist country in Europe. Thereafter, Albania experienced a major socioeconomic upheaval, accompanied by massive emigration (Burazeri et al., 2007b). Subsequently, changes took place in lifestyle that are thought to include decreased physical activity (Shapo et al., 2004).
Our aim was to assess the association of leisure-time exercise and TV viewing with CHD among residents of Tirana, a city undergoing particularly rapid transition.
Section snippets
Methods
A population-based case-control study of acute coronary syndrome (ACS) was conducted in Tirana in 2003–2006 (Burazeri et al., 2007a). We recruited 467 consecutive non-fatal ACS cases (Q-wave and non-Q-wave myocardial infarction and unstable angina pectoris as defined by symptoms, electrocardiograph, ultrasound and enzymes), aged 35–74 years, admitted to the University Hospital Centre, the only hospital serving Tirana (370 men aged 59.1 ± 8.7 years, and 97 women 63.3 ± 7.1 years; 88% response). The
Results
Crude mean daily energy expenditure (kcal) from leisure-time exercise was lower in ACS cases than controls (men: 100 ± 80 vs 179 ± 151, age-adjusted P < 0.01; women: 58 ± 51 vs 155 ± 127, P = 0.10). The average daily hours of TV viewing was higher in cases than controls (men: 2.42 ± 1.83 vs 1.86 ± 1.64; women: 1.96 ± 1.75 vs 1.66 ± 1.40; age-adjusted P < 0.01 for both) (Table 1).
TV viewing was associated with ACS (age-adjusted OR = 1.17 per hour, 95%CI = 1.07–1.28 in men; OR = 1.45, 95%CI = 1.18–1.79 in women) and with
Discussion
The main findings are an age-adjusted association (in both sexes) and a strong multivariable-adjusted association (restricted to women) of TV viewing with ACS, and a substantive association of leisure-time inactivity with ACS that was of similar magnitude in both sexes (although confidence intervals were wide in women due to the smaller sample size). The association of TV viewing with ACS in Tirana women was not mediated through the strong association of TV viewing with obesity [r = 0.52 in
Conclusions
This study, consistent with the literature elsewhere, provides evidence for the importance of leisure-time inactivity as a modifiable risk factor for CHD in Albania, a country in particularly rapid transition towards a market-oriented economy. Furthermore, TV viewing may serve as a simple, inexpensive and informative additional marker that may be useful to community health workers and primary health care professionals to identify people at increased coronary risk, especially women.
Acknowledgments
Genc Burazeri was a recipient of an Irma Milstein International Doctoral Fellowship at the Hebrew University—Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel. The study was supported by the Irma Milstein Doctoral Program.
Mrs. Milva Ekonomi, former director of the Institute of Statistics in Tirana, helped in drawing a population-representative control group from the census conducted in Albania in 2001.
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